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Telepsychotherapy for the Treatment of Trichotillomania: a Randomized Controlled Trial

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Telepsychotherapy for the Treatment of Trichotillomania: a Randomized Controlled Trial Utah State University DigitalCommons@USU All Graduate Theses and Dissertations Graduate Studies 5-2018 Telepsychotherapy for the Treatment of Trichotillomania: A Randomized Controlled Trial Eric B. Lee Utah State University Follow this and additional works at: https://digitalcommons.usu.edu/etd Part of the Psychology Commons Recommended Citation Lee, Eric B., "Telepsychotherapy for the Treatment of Trichotillomania: A Randomized Controlled Trial" (2018). All Graduate Theses and Dissertations. 7012. https://digitalcommons.usu.edu/etd/7012 This Dissertation is brought to you for free and open access by the Graduate Studies at DigitalCommons@USU. It has been accepted for inclusion in All Graduate Theses and Dissertations by an authorized administrator of DigitalCommons@USU. For more information, please contact [email protected]. i TELEPSYCHOTHERAPY FOR THE TREATMENT OF TRICHOTILLOMANIA: A RANDOMIZED CONTROLLED TRIAL by Eric B. Lee A dissertation submitted in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY in Psychology Approved: ___________________________ ___________________________ Michael P. Twohig, Ph.D. Michael E. Levin, Ph.D. Major Professor Committee Member ___________________________ ___________________________ Melanie M. Domenech Rodríguez, Ph.D. Rick A. Cruz, Ph.D. Committee Member Committee Member ___________________________ ___________________________ Karen F. Muñoz, Ed.D. Mark McLellan, Ph.D. Committee Member Vice President for Research and Dean of the School of Graduate Studies UTAH STATE UNIVERSITY Logan, Utah 2018 ii Copyright © Eric B. Lee 2018 All Rights Reserved iii ABSTRACT Telepsychotherapy for the Treatment of Trichotillomania: A Randomized Controlled Trial by Eric B. Lee Utah State University, 2018 Major Professor: Dr. Michael P. Twohig Department: Psychology Trichotillomania is defined as recurrent pulling of one’s hair that results in distress and negative effects on general functioning and quality of life. Estimates of trichotillomania lifetime prevalence generally range from approximately 1% to 3% and it is likely as common as disorders such as obsessive-compulsive disorder and agoraphobia. Yet, quality treatment for trichotillomania is often difficult to find as many mental health professionals are uninformed about the disorder and its treatment. Moreover, mental health services in general are inaccessible to many with estimates suggesting that 96.5 million people do not have access to adequate services. The use of telepsychology has been an effective method for disseminating treatment services for a variety of mental health conditions. However, no research has examined the effectiveness of telepsychology to treat trichotillomania. The current study reports the results of a randomized clinical trial of Acceptance and Commitment Therapy Enhanced Behavior Therapy for the treatment of trichotillomania delivered by way of telepsychology. The study compared an active treatment condition (n = 12) to a waitlist control condition (n = 10). Results showed iv significant reductions in hair pulling severity from pre- to post-treatment compared to the waitlist condition. Participants in the waitlist condition received the same treatment as participants in the treatment condition following the waitlist period. All participants were then combined to examine overall treatment effects from pre-treatment to a 12-week follow-up. The effect of treatment on hair pulling severity was still significant at follow-up, however the effect was not as strong as at post-treatment. Conversely, the effect on quality of life was maintained and even increased following post-treatment. Additional measures of psychological flexibility, perceived shame, and valued action also saw significant changes from pre-treatment to follow-up. The findings demonstrate that telepsychology is a viable option to disseminate treatment for trichotillomania. Implications, limitations, and future research directions are discussed. (131 pages) v ACKNOWLEDGMENTS To my greatest professional mentors. Chad Wetterneck—for seeing something in me and patiently helping me find it. For your compassion and life lessons. Michael Twohig—for your unwavering trust and confidence in me. For your scientific acumen and pragmatism. For pushing me in every way. Thank you both. I owe my ability to complete this project to you. To my lab colleagues—for brain storming sessions and collaboration. For your various ideas and opinions and patience with my own. For your friendship and constant support. Thank you. And most importantly, to Rebecca—for the long nights, the pep talks, the comic relief, and the wisdom. Thank you. These years (and years) of education adventures would not have been possible without your sustained strength and advocacy. This truly has been a joint effort. I can’t wait for the adventures to come… Eric B. Lee vi TABLE OF CONTENTS Page ABSTRACT ....................................................................................................................... iii ACKNOWLEDGMENTS .................................................................................................. v LIST OF TABLES ........................................................................................................... viii LIST OF FIGURES ........................................................................................................... ix CHAPTER I. STATEMENT OF THE PROBLEM .......................................................... 1 II. REVIEW OF THE LITERATURE ............................................................ 4 Trichotillomania ........................................................................................ 4 Prevalence ........................................................................................... 6 Cultural and Racial Considerations .................................................... 6 Sex Distribution .................................................................................. 8 Treatment ............................................................................................ 9 Telepsychology ....................................................................................... 15 Conclusion .............................................................................................. 18 III. METHOD ................................................................................................. 19 Participants .............................................................................................. 19 Design ..................................................................................................... 23 Procedures ............................................................................................... 24 Telepsychology Procedures .............................................................. 25 Treatment ................................................................................................ 26 Measures ................................................................................................. 26 Diagnostic Assessments and Clinical Tools ..................................... 26 Primary Outcome Measures .............................................................. 28 Secondary Process Measures ............................................................ 29 Treatment Acceptability Measures ................................................... 31 Data Analytic Strategy ............................................................................ 32 Primary Analysis ............................................................................... 33 Secondary Analysis ........................................................................... 34 IV. RESULTS ................................................................................................. 35 Treatment Adherence .............................................................................. 35 Examination of Data ............................................................................... 36 Differences Between Conditions ...................................................... 37 Condition Comparison Summary ........................................................... 39 Effects on Hair Pulling Severity ....................................................... 42 Effects on Quality of Life ................................................................. 42 Effects on Psychological Flexibility ................................................. 42 Effects on Shame .............................................................................. 43 Effects on Values .............................................................................. 44 vii Combined Follow-up Analysis ............................................................... 45 Effects on Hair Pulling Severity ....................................................... 45 Effects on Quality of Life ................................................................. 45 Effects on Psychological Flexibility ................................................. 46 Effects on Shame .............................................................................. 46 Effects on Values .............................................................................. 47 Telehealth Factors ................................................................................... 50 Working Alliance .................................................................................... 51 Treatment Satisfaction ...........................................................................
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